Provider Demographics
NPI:1609087675
Name:WELLNESSONE OF LINCOLN, INC.
Entity Type:Organization
Organization Name:WELLNESSONE OF LINCOLN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-420-5303
Mailing Address - Street 1:4210 PIONEER WOODS DR.
Mailing Address - Street 2:STE B
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7550
Mailing Address - Country:US
Mailing Address - Phone:402-484-0200
Mailing Address - Fax:402-484-5677
Practice Address - Street 1:4210 PIONEER WOODS DR.
Practice Address - Street 2:STE B
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-7550
Practice Address - Country:US
Practice Address - Phone:402-484-0200
Practice Address - Fax:402-484-5677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1553111N00000X
NE968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025154200Medicaid
NE09751OtherBLUE CROSS BLUE SHIELD NE
NE10025154200Medicaid
NE09751OtherBLUE CROSS BLUE SHIELD NE